Provider Demographics
NPI:1144455601
Name:HERNICK, ELIZABETH MARY (GNP-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARY
Last Name:HERNICK
Suffix:
Gender:F
Credentials:GNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:SMIEJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 14611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:864-306-2544
Practice Address - Street 1:CORPORATE OFFICE
Practice Address - Street 2:3523 PELHAM RD, SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4191
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:864-306-2544
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19157363LG0600X
MNR106798-7163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3148Medicaid
SCSC5297E243Medicare PIN
SCSC44538753Medicare PIN